The purpose of this study is to determine the efficacy of Vismodegib drug in treatment of patients with relapsed or refractory B-cell lymphoma or chronic lymphocytic leukemia (CLL).
This is a multicenter open-label phase II study. Primary objective: To evaluate the efficacy of vismodegib in patients with relapsed/refractory B-cell lymphoma and CLL as measured by the best overall response rate (ORR) during the treatment period. Secondary objectives: * To evaluate the tolerability and the safety of vismodegib in patients with relapsed/refractory B-cell lymphoma and CLL * To evaluate the efficacy of vismodegib in patients with relapsed/refractory B-cell lymphoma and CLL by measuring the overall (OR) and complete response (CR) rate during the study period, the maximum tumor shrinkage, the duration of response, the progression-free survival (PFS) and the overall survival (OS). * To examine the expression of GLI-1 and other Hedgehog (Hh) signalling components in the tumor specimens before and during treatment with vismodegib and corresponding efficacy in patients. 44 patients will be included in the study equally distributed into 4 cohorts according to their histological subtype: * Cohort 1: 11 patients with Diffuse large B-cell lymphomas (DLBCL) * Cohort 2: 11 patients with "indolent" lymphomas (iNHL): Follicular (FL), mantle cell (MCL) and marginal zone lymphoma (MZL) lymphoplasmacytic lymphoma (LPL)/ Waldenstrom macroglobulinemia (WM), small lymphocytic lymphoma (SLL) * Cohort 3: 11 patients with Primary central nervous system lymphomas (PCNSL) * Cohort 4: 11 patients with Chronic lymphocytic leukemia (CLL). After 28 days screening period (Baseline), each patient will be treated by Vismodegib 150 mg per os during for a maximum of 12 months until disease progression, unacceptable toxicities, patient consent withdrawal, death, reasons deemed by the treating physician or study termination by the Sponsor. Tumour assessment (clinical examination, laboratory tests, abdominal and chest CT scan (for PCNSL only at baseline), +/- PET scan for DLBCL, +/- brain MRI and CSF examination and ophthalmic examination for PCNSL, +/- bone marrow examination (except for PCNSL) will be performed at baseline, and then every 2 months during the first 6 months of treatment, and every 3 months thereafter until disease progression or up to 6 months after study treatment stop. Response to treatment will be assessed also by Pharmacodynamic study in tumor samples by immunohistochimic and qPCR analysis at baseline and after one month of treatment with vismodegib. Pharmacokinetic studies (before and after 1 month of treatment) will also be performed. After study treatment discontinuation, the patients will be followed up every 3 months until disease progression or up to 6 months (after 1 year treatement).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
31
150 mg (1 capsule) of Vismodegib per day orally in continue during 12 months
Hôpital Henri MONDOR
Créteil, France
CHU Dijon _ Hôpital d'Enfants
Dijon, France
CHRU de Lille _ Hôpital Huriez
Lille, France
CHU de Nantes _ Hôtel Dieu
Nantes, France
The best overall response rate(ORR)
ORR will be measured by the best overall response (complete response (CR), uncofirmed complete response (CRu) or partial response (PR)) recorded during whole treatment period from the baseline until the end of treatment. ORR will be assessed according to Cheson 1999 for DLBCL and iNHL, according to Abey 2005 (IPCG response criteria) for PCNSL and to Hallek 2008 (IWCLL response criteria) for CLL.
Time frame: 12 months
Overall Response rate
Overall response rate will be evaluated as ORR, CR, CRu, PR, stable disease (SD) and progressive disease (PD) after 2, 4, 6, 9, and 12 months of treatment and every 3 months for 6 months after treatment discontinuation, until disease progression.
Time frame: 2, 4, 6, 9, and 12 months
Progression Free Survival (PFS)
Progression-Free Survival will be measured from the date of inclusion to the date of first documented disease progression, relapse or death from any cause. Responding patients and patients who are lost to follow up will be censored at their last tumor assessment date.
Time frame: Up to 3 year
Response Duration
Duration of response will be measured from the time of attainment of first CR, CRu or PR to the date of first documented disease progression, relapse or death from any cause. Subjects with no documented progression after CR, CRu or PR will be censored at the last tumor assessment date.
Time frame: Up to 3 year
Overall survival
Overall survival will be measured from the date of inclusion to the date of death from any cause. Alive patients will be censored at their last date known to be alive.
Time frame: Up to 3 year
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Hôpital Saint-Louis
Paris, France
CHU Haut Lévèque
Pessac, France
CH Lyon Sud
Pierre-Bénite, France
CHU Pontchaillou
Rennes, France
Centre Henri Becquerel
Rouen, France
Hôpital René Huguenin _ Institut Curie
Saint-Cloud, France
Correlation between Hedgehog (Hh) signaling in the tumor and the efficacy of Vismodegib
Hh signaling cascade will be evaluated in tumors at baseline and at the end of cycle 1 (at Day 28 +/- 7 days) in order to: * Study pharmacodynamic of the drug (extinction of Hh signaling under treatment with Vismodegib) * Search for correlation between Hh signaling and clinical response to Vismodegib
Time frame: At baseline and at 28 days (+/- 7 days)
Safety endpoints
Description of all adverse events (AEs), laboratory data, vital signs and ECOG performance status, performed by cycle/visit and for the entire study.
Time frame: Up to 2 year
Overall Response rate
Overall response will also be assessed using the Cheson 2007 criteria in patients with DLBCL. Patient without response assessment (due to whatever reason) will be considered as non-responder.
Time frame: 12 months